Perineal Reconstruction With the Profunda Artery Perforator Flap

Abstract

Background: Abdominoperineal resection is used to treat a variety of colorectal pathologies. Traditionally, the vertical rectus abdominis myocutaneous flap has been most commonly used for reconstruction. Here, we explore the role of the profunda artery perforator (PAP) flap for perineal reconstruction. Methods: A prospectively maintained database was retrospectively analyzed to identify patients who had undergone perineal reconstruction with a pedicled PAP flap. Parameters of interest included age, sex, body mass index, primary diagnosis, comorbidities, and history of radiation, and postoperative complications. Results: Fifteen patients (5 men and 10 women) with a median age of 52 years (interquartile range, 48.5-61.5 years) were included in the study. Median body mass index was 26.3 kg/m 2 (interquartile range, 24.0-29.3 kg/m 2 ). Patients underwent abdominoperineal resection for treatment of rectal cancer (n = 9, 60.0%), recurrent anal squamous cell carcinoma (n = 3, 20.0%), and Crohn's disease (n = 3, 20.0%). Twelve patients (80.0%) underwent neoadjuvant radiotherapy. Eight patients (53.3%) experienced a total of 10 complications (2 major and 8 minor). The most common complication was donor (n = 3, 20.0%)/recipient (n = 3, 20.0%) site wound dehiscence. Stable soft tissue coverage was achieved in all patients. Conclusions: The PAP flap provides stable soft tissue coverage of perineal defects with a low donor-site morbidity. This flap should be strongly considered in the reconstructive algorithm when approaching perineal defects.

The profunda artery perforator flap for upper limb reconstruction: A case report and literature review on the flap applications in reconstruction

“…Originally the PAP flap was described as a pedicled option for ischiatic pressure sores (Arquette et al, 2022 ; Homma et al, 2001 ; Kim et al, 2014 ; Lee et al, 2009 ; Sharp et al, 2021 ) and as a free flap for head and neck reconstruction, including tongue (Heredero et al, 2021 ; Riera et al, 2017 ; Scaglioni et al, 2015 ). A recent expanding use is for breast reconstruction (Ahmadzadeh et al, 2007 ; Allen et al, 2012 , 2016 ; Angrigiani et al, 2001 ; Atzeni et al, 2021 ; Cho et al, 2021 ; Jo et al, 2022 ; Martinez et al, 2021 ; Murphy et al, 2021 ; Saad et al, 2012 ; Song et al, 2020 ; Yano et al, 2020 ).…”

Topical vanadate improves tensile strength and alters collagen organisation of excisional wounds in a mouse model

“…Although some cases may be clinically inconsequential with observation sufficing instead of treatment, dehiscence can also precipitate severe life‐threatening complications that require emergent returns to the operating room. Dehiscence has been well‐documented in various instances of high‐tension primary closures across the aesthetic and reconstructive spectrum 3–6 . Some studies suggest up to 7% of wide flap donor sites, the latissimus dorsi and anterolateral thigh flaps in particular, suffer from dehiscence when closed primarily 7,8 .…”

“…Dehiscence has been well-documented in various instances of hightension primary closures across the aesthetic and reconstructive spectrum. [3][4][5][6] Some studies suggest up to 7% of wide flap donor sites, the latissimus dorsi and anterolateral thigh flaps in particular, suffer from dehiscence when closed primarily. 7,8 Some surgeons abide by maximum graft width cutoffs, above which skin grafting is the preferred method of closure, so as to avoid higher risks of dehiscence among other complications.…”

Penoscrotal defect reconstruction using loco‐regional flaps in treatment of extramammary Paget's disease: Experience and suggestion of a simplified algorithm

“…Regarding the reconstruction of perineal defects, numerous studies have been published, with introducing diverse kinds of flaps including regional musculocutaneous flaps or perforator flaps, (Arquette et al, 2022; Ayestaray & Proske, 2015; Boissière et al, 2019; Han et al, 2018; Han et al, 2019; Kosutic et al, 2016; Ordenana et al, 2021; Ratanshi et al, 2017; Unverdi & Kemaloglu, 2019) and with suggesting several algorithms for selecting appropriate options based on defect size or anatomical subunits (Ahn et al, 2014; Chen et al, 2011; Guo et al, 2019; Hong et al, 2017; Xu et al, 2021; Zelken et al, 2016). Despite their elaborate works, most of them included only a small number of cases, which might not be sufficient to validate reliability and versatility of suggested reconstruction strategies, given a considerable diversity of perineal defects in terms of dimension, depth, and involved anatomical subunits.…”

“…Regarding the reconstruction of perineal defects, numerous studies have been published, with introducing diverse kinds of flaps including regional musculocutaneous flaps or perforator flaps, (Arquette et al, 2022;Ayestaray & Proske, 2015;Boissière et al, 2019;Han et al, 2018;Han et al, 2019;Kosutic et al, 2016;Ordenana et al, 2021;Ratanshi et al, 2017;Unverdi & Kemaloglu, 2019) and with suggesting several algorithms for selecting appropriate options based on defect size or anatomical subunits (Ahn et al, 2014;Chen et al, 2011;Guo et al, 2019;Hong et al, 2017;Xu et al, 2021;Zelken et al, 2016).…”